Elective orthopaedic surgery comprises a significant amount of the UK NHS elective workload. With an ageing population, the demand for these services is expected to increase [1]. A cohort study of patients aged > 60 y undergoing elective orthopaedic surgery showed that more than half of all patients had some form of neurocognitive disorder five years after surgery, and this was major in 16.8% [2]. This is higher than the population prevalence of 6.8%, suggesting that anaesthesia and surgery may contribute to cognitive decline.

These findings indicate that a considerable proportion of patients experience cognitive decline within five years of undergoing what is, typically, non-life-threatening or non-essential surgery. It is unlikely that we are counselling our patients adequately pre-operatively about this significant risk of morbidity.

Consent in anaesthesia is a multifaceted and broad subject. The Association of Anaesthetists' 2017 guidelines recommend informing patients about common components of anaesthetic techniques, procedure-specific risks and common or significant adverse effects [3]. Ultimately, it is the responsibility of the clinician to decide what information is most relevant for each individual patient.

In an editorial, Meek discusses the complexity of consent in the context of data from the 7th National Audit Project, which explored the incidence of potentially serious complications from anaesthesia [4]. The project captured extensive UK data, providing valuable information on complication rates [5]. However, interpreting the data and using them appropriately is where the challenges lie.

The landmark Montgomery vs. Lanarkshire Health Board case in 2015 stressed the necessity of informed consent. The ruling clearly has a considerable impact on the way anaesthetists approach the consent process. The exhaustive list of anaesthesia risks, combined with the limited time often available for pre-operative discussions, makes it challenging to cover all potential risks in depth. Patients are also more likely to agree with the anaesthetist on the morning of surgery, feeling committed to the procedure despite possible risks [6].

The study by Atkins et al. highlights the importance of informed consent for anaesthesia, indicating that the risk of cognitive decline may outweigh the risks of the surgery in some cases [2]. Pre-operative clinics and assessments should integrate these findings, allowing patients to consider their options as early as possible. The Association of Anaesthetists is currently reviewing its guidelines on consent and an updated version is forthcoming.

择期骨科手术占英国 NHS 择期手术工作量的很大一部分。随着人口老龄化，预计对这些服务的需求将会增加 [1]。一项针对 > 60 岁接受择期骨科手术的患者的队列研究表明，超过一半的患者在手术后 5 年患有某种形式的神经认知障碍，其中 16.8% 的患者是严重的 [2]。这高于 6.8% 的人群患病率，表明麻醉和手术可能导致认知能力下降。

这些发现表明，相当大一部分患者在接受通常不会危及生命或非必要的手术后五年内出现认知能力下降。我们不太可能在术前就这种重大的发病风险对患者进行充分的咨询。

麻醉中的同意是一个多方面和广泛的主题。麻醉医师协会 2017 年指南建议告知患者麻醉技术的常见组成部分、手术特定风险以及常见或显著的不良反应 [3]。最终，临床医生有责任决定哪些信息与每位患者最相关。

在一篇社论中，Meek 在第 7 次国家审计项目的数据背景下讨论了同意的复杂性，该项目探讨了麻醉可能导致严重并发症的发生率 [4]。该项目捕获了大量英国数据，提供了有关并发症发生率的宝贵信息 [5]。然而，解释数据并适当地使用它们是挑战所在。

2015 年具有里程碑意义的蒙哥马利诉拉纳克郡卫生局案强调了知情同意的必要性。该裁决显然对麻醉师处理同意过程的方式产生了相当大的影响。详尽的麻醉风险清单，加上通常用于术前讨论的时间有限，使得深入涵盖所有潜在风险变得具有挑战性。患者也更有可能在手术当天早上同意麻醉师的意见，尽管可能存在风险，但他们仍然对手术感到坚定 [6]。

Atkins 等人的研究强调了知情同意对麻醉的重要性，表明在某些情况下，认知能力下降的风险可能超过手术的风险 [2]。术前门诊和评估应整合这些发现，让患者尽早考虑他们的选择。麻醉师协会目前正在审查其关于同意的指南，更新版本即将发布。